Abstract: Objective To analyze the elimination of pilot candidates from South China due to abnormal ECG before and after climbing ladder exercise test. Methods The ECG and blood pressure about 5 604 senior middle school graduates and 171 university students at rest and after climbing ladder exercise test during the pilot recruit physical examination in 2004-2008 were retrospectively analyzed.Their 12-lead ECG at rest was recorded before the climbing ladder exercise test.Those with a normal ECG underwent the climbing ladder exercise test following the air force pilot recruit physical examination methods. Results A total of 398 candidates（6.9%） were eliminated according to their ECG and blood pressure.Of the 398 eliminated candidates,225（3.9%） were eliminated due to abnormal ECG at rest and 173（3.0%） were eliminated due to abnormal climbing ladder exercise test.The elimination proportion was 22.2%/19.1% due to right/left axis deviation,14.7% were eliminated due to T wave change,and 10.7% were eliminated due to premature ventricular contraction on abnormal ECG at rest.The axis deviation on ECG at rest was the first reason of elimination.The elimination proportion was 60.7% due to ST-T change on abnormal ECG after the climbing ladder exercise test.The elimination rate was significantly different before and after the climbing ladder exercise test（χ²=50.779 1,P＜0.01）. Conclusion Climbing ladder exercise test is helpful to show more abnormal ECG findings.Standard treadmill exercise test should be performed to improve pilot recruit physical examination.